Vanderbilt University Medical Center Joins Medtronic InterStim Micro ELITE Study

Vanderbilt University Medical Center is joining Medtronic’s ELITE clinical study of patients receiving the InterStim Micro sacral neuromodulation device. “Very, very few patients are offered advanced therapies and what we are able to accomplish at Vanderbilt is offer patients who have failed behavioral and medical therapies an opportunity to regain their quality of life,” said Dr. Melissa Kaufman, MD, PhD, professor of Urology and chief of the Division of Reconstructive Urology and Pelvic Health at Vanderbilt University Medical Center.

VUMC’s ELITE Study Participation

The ELITE clinical trial will enroll up to 40 medical centers, including VUMC, to study 200 patients for two years. The goal is to better understand how living with the InterStim Micro impacts both their bowel and bladder control issue and their everyday lives. “[The InterStim Micro] is an exceptionally powerful technology and the ELITE study is one of several clinical trials for these devices that we have been involved in through the years,” said Dr. Kaufman.

Dr. Kaufman’s team implants an average of 10 to 15 devices per month and has been performing surgeries since the device was approved in 1997. Sacral neuromodulation is an area of significant advancement in treating pelvic floor issues and offers immense relief to patients.

Incontinence: Widespread and Undertreated

Bowel and bladder incontinence affects almost one out of every six Americans, an estimated 37 million people. The causes are wide-ranging, including neurological disorders, enlarged prostate or prostate cancer, childbirth, hormone loss such as during menopause, an injury to the back or pelvic region, and a number of other health conditions. 

In addition to the physical symptoms, Dr. Kaufman said 90% of patients who have urgency incontinence also report mental health issues. Fear of leakage and the attached stigma causes those affected to withdraw from everyday life and experience isolation, depression and feelings of hopelessness. 

Dr. Kaufman noted having observed this in her patients: “Patients are reticent to discuss it with their providers and therefore are undertreated. I have patients who have lost the capacity to go about any of their normal daily activities and avoid any company because of their fear of leakage.”

InterStim Micro Upgrades, Surgery and Recovery

The InterStim Micro device is the latest iteration of Medtronic’s endeavor to improve the reduced quality of life so many people experience. It’s a new version of the original device that’s been in use since 1997 when it was first approved by the FDA. 

Unlike the previous model, the InterStim Micro has a rechargeable battery and allows for full-body MRIs without needing to be removed. The device works by helping the bladder reprogram how it senses filling and storage of urine, in order to reduce instances of urgency incontinence, said Dr. Kaufman. It stimulates peripheral nerves that send messages to the bladder. 

During outpatient surgery, two small incisions are made above the buttocks near the sacrum, and the device is implanted. Recovery is relatively minimal, with pain medication for several days after surgery and only light activity for several weeks. 

Did you know that up to 11% of the male population suffers from urinary incontinence? This is a lower percentage than for women, but, this does not diminish the fact that millions of men must cope with urinary incontinence. If you are a man who suffers from UI, know that you are not alone.

Types of Incontinence

The types of incontinence in men are comprised of three main categories: Stress Incontinence, Urge Incontinence, and Overflow Incontinence. Stress Incontinence means that a person will lose urine involuntarily when their body is put under stress, possibly from lifting heavy objects, coughing, or even laughing. Urge Incontinence is when a person feels a sudden, urgent, and unstoppable urge to urinate. Finally, Overflow Incontinence means that urine leaks consistently and is characterized by frequent urination, often in small amounts. Those who suffer from incontinence may experience one, two, or all three of these types.

Central Nervous System (CNS)

Male Urinary Incontinence is often associated with nervous system problems. Diabetes has the potential to cause nerve damage over time, which can result in loss of bladder control. And, a stroke, Parkinson’s Disease, and Multiple Sclerosis can all cause urinary symptoms. The Central Nervous System (CNS) is critical to proper bladder function, so anything which interrupts nerve signals to the bladder has the potential to result in incontinence.

Prostate Related Incontinence

While nervous system related incontinence is possible for both men and women, the prostate presents a uniquely male cause for Urinary Incontinence. As a man ages, a process called Benign Prostate Hyperplasia (BPH) can occur, which simply means that the prostate has increased in size. As the prostate enlarges, it can begin to put pressure on the urethra. This pressure can result in a number of urinary symptoms, ranging from hesitancy to urge incontinence. When this happens, difficulty starting and maintaining a stream of urine is common, and, Overflow Incontinence also frequently reported. While removal of an enlarged or cancerous prostate may seem like the solution to this problem, Radical Prostatectomy, the total removal of the prostate, can result in Urinary Incontinence symptoms of its own.

As always, prior to self-diagnosis and taking symptom management into your own hands, meet with a medical professional to receive a diagnosis and implement a treatment plan. Our board-certified, industry-leading physicians address the needs of patients suffering from Urinary and Fecal Incontinence with customized treatment plans, supported by cutting-edge technology and procedures.

If you are suffering any of the above symptoms, or if bladder overactivity is drastically affecting your daily life, reach out to one of our medical professionals to see how you can restore yourself to a higher quality of life. Call 1.615.547.2938 to schedule a consultation today, and let us empower you to live the leak-free life you deserve.

Resources:

• https://www.medicinenet.com/urinary_incontinence/article.htm#how_is_urinary_incontinence_ui_in_men_diagnosed
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476070/

Nocturia refers to nighttime urination – people who have nocturia wake up frequently to use the bathroom. Though all incontinence is characterized by its disruption of daily life, nocturia is particularly impactful because it interrupts a key human function – sleep. So, alongside frequent urination, leaks, and the inability to control one’s bladder, individuals who wake up two or more times at night to use the restroom often suffer from lower quality sleep. Consistent sleep disturbance can translate to lethargy during waking hours and may contribute to the development of depression, dysfunctional mood regulation, as well as the incidence of type 2 diabetes (T2D), obesity, and cardiovascular disease.

What Causes Frequent Nighttime Urination?

Nocturia can be a side effect of underlying bladder issues, a medication side effect, as well as symptom of an underlying medical condition. However, causes may also be impacted by individual behavior. Nocturia may very well be a byproduct of the beverages that an individual consumes – particularly those close to bedtime. Caffeinated drinks like soda and coffee, as well as alcohol, can contribute to this problem. In some cases, individuals are simply drinking too much right before bed.

There are several different reasons people may actually make more urine at night, which can be one cause of nocturia. These are as follows:

• Nocturnal polyuria: When the body produces greater-than-average amounts of urine at night. While you sleep, your body produces smaller amounts of more concentrated urine, in comparison to your waking hours. Ideally as a result an individual is able to sleep 6-8 hours without interruption. An individual may be diagnosed with nocturnal polyuria when their nighttime urine volume exceeds 20-30% of their total urine volume over the course of one day.
• Global polyuria: Just like nocturnal polyuria, this is an overproduction of urine. However, this overproduction occurs during waking hours, as well.

Outside of these causes, the onset of nocturia in women may be triggered by the impacts of pregnancy or childbirth, menopause, and/or pelvic organ prolapse. In contrast, nocturia in men may be attributed to an enlarged prostate. In both men and women, it is critical to have a health care provider determine if the nocturia is from a lower urinary tract or systemic cause.

How to Stop Frequent Urination at Night

As always, prior to self-diagnosis and taking symptom management into your own hands, meet with a medical professional to receive a diagnosis and implement a treatment plan. Our board-certified, industry leading physicians address the needs of patients suffering from nocturia with customized treatment plans supported by cutting-edge technology and procedures.

If you are suffering any of the above symptoms, or if bladder over activity is drastically affecting your daily life, reach out to one of our medical professionals to see how you can restore yourself to a higher quality of life. Call 1.888.741.6403 to schedule a consultation today, and let us empower you to live the leak-free life you deserve.

You take a multivitamin and maybe calcium or Vitamin D for your bones – but do you take anything for incontinence? Is that even possible?

If you are trying to live a more natural lifestyle, you are probably familiar with various vitamins and supplements. Millions of Americans take vitamins and supplements, from Vitamin C to ward off colds in the winter to melatonin to help them sleep. However, it is important to note that almost all vitamins and supplements are not tested or approved by the Food & Drug Administration (FDA).

The FDA states, “According to the American Academy of Family Physicians (AAFP), a doctor may recommend that you take them for certain health problems, if you eat a vegetarian or vegan diet, or if you are pregnant or breastfeeding.” The FDA continues, “The 2005 Dietary Guidelines for Americans advises that nutrient needs be met primarily through consuming foods, with supplementation suggested for certain sensitive populations.”

The FDA’s main gripe with over-the-counter vitamins and supplements is that many of them can interact with other medications including prescription medication. It can also be harmful to take many of the same supplement. Many people do get enough vitamins through a healthy diet, and certainly that is what is recommended. But for targeting specific conditions or areas, there are vitamins and supplements available. It is vital, though, to speak with your physician before starting a vitamin regimen. You need to ensure that nothing will interact with your current medications.

Supplements for Incontinence and Overactive Bladder

Vitamin D

Recent studies found that women over the age of 20 with normal vitamin D ranges were much less likely to suffer from a pelvic floor disorder, like incontinence. If you suffer from a pelvic floor disorder it may be time to check your vitamin D levels through a simple blood test.

Gosha-jinki-gan

This is a Japanese blend of different herbs. It is actually one of the most-studied herbs used in treatment for overactive bladder syndrome. A study found that, “Gosha-jinki-gan could be a safe and effective potential therapeutic alternative in females with overactive bladder.” Another study said that its results “suggest that Gosha-jinki-gan inhibits bladder activity by maintaining the balance of the sympathetic and parasympathetic nervous systems at a low level.” This herb helps control overactive bladder symptoms by helping balance the nervous system transmission from the brain telling the bladder it has to go so often.

Buchu

Buchu extract, or Barosma betulina, is a shrub native to South Africa. The dried leaves and supplements made from them have been used to treat urinary tract infections. It is thought that Buchu helps to promote urine flow, and overall health of the urinary tract. According to an article in Reviews in Urology, no clinical trials have been done regarding Buchu and overactive bladder.

Cornsilk

Cornsilk is the fibers at the top of an ear of corn. In supplement or tea form, cornsilk has been used to treat bladder infections and prostate inflammation. It is thought to soothe the urinary tract, and was even used by the ancient Incas. There are no clinical studies on the effect of cornsilk and urinary incontinence or irritation.

Saw palmetto

Saw palmetto is a palm that grows in the southern United States. Its berries were used by Native Americans for their medicinal properties. Saw palmetto supplements are used to treat benign prostate hyperplasia (enlarged prostate) in men. This condition can lead to excessive urination, or only partial emptying of the bladder. Saw palmetto has been studied – a large analysis of multiple studies concluded that saw palmetto produced a similar benefit to finasteride, a drug for enlarged prostate, and was better-tolerated. Saw palmetto may also boost the quality of life for men with enlarged prostate.

Magnesium

Magnesium is important for proper muscle and nerve function. Some doctors believe better magnesium levels can reduce bladder spasms, a common cause of incontinence. Magnesium levels can be checked through a blood test at your next doctor’s visit.

Ganoderma lucidum

This mushroom has been used in Chinese medicine for over 2,000 years. Recently, a Japanese study showed that ganoderma lucidum helped people with urge incontinence after eight weeks of use. Why? The mushroom lowers the hormone levels associated with prostate growth, a lead cause of overflow incontinence in men.

Urinary Incontinence in Middle Tennessee

If you are suffering from urinary incontinence, overactive bladder syndrome, or enlarged prostate, it may be worth it to try natural supplements. Of course, you need to consult your physician before starting vitamins or supplements, to ensure they will not react with your medications or have any adverse effects. If you live around Nashville, Tennessee our team of expert physicians would love to help. Contact our discreet, dedicated Medical Concierge by phone or private message today.

Pelvic pain affects one in four women.  Many women live in silence, not knowing it can be helped. And many women who do seek help may have unnecessary surgeries, such as hysterectomy.

What is pelvic pain?

Pelvic pain is pain or pressure felt anywhere in the abdomen below the navel. It may be intermittent or constant. Many women describe pelvic pain as a dull ache, sharp pains, “toothache” type pain, and/or burning. Other symptoms include pelvic pain/cramps that may be related to menses, or completely independent of a period, pain associated with sex, during or afterward. Women can also have painful ovulation, painful bowel movements, pain with urination, and low back or hip pain.

Pelvic pain in women is complex and can originate from different organ systems such as the female reproductive system, the gastrointestinal system, the urinary system, the musculoskeletal system, the neurological system, or some combination thereof.

Usually, temporary pelvic pain is not a cause for concern and can be treated with over the counter NSAIDS. For more chronic pain, there may be the need for further treatment options, which can include physical therapy, acupuncture, nerve stimulation, amniotic fluid allograft injections.  However, the first necessity is to have an evaluation and determine all the causes of the pain, and what organ systems are affected.  This will require a physical examination and may require cystoscopic and/or laparoscopic evaluation along with possible colonoscopy.

Here to discuss different types of pelvic pain and treatment options is Dr. Barry Jarnagin, urogynecologist with the Incontinence Institute and the Center for Pelvic Health in Franklin, TN:

What symptoms do most women mention when they come to see you for pelvic pain?

Most women complain that their quality of life is greatly diminished by their pain.  They have trouble doing their daily tasks, caring for their children, working, and having an intimate relationship with their partner.

Are there other conditions that bring women in to see you, and then you learn they have pelvic pain?

Many times, women will have urinary and/or gastrointestinal problems (urinary incontinence, urgency, frequency, constipation, and diarrhea) who, after questioning them, admit to chronic pelvic pain and/or pain with sex.

Can pelvic pain be an indicator of a more serious problem?

It certainly can, and a full evaluation is warranted.  And, while most of the time it is a quality of life issue, it needs a full evaluation.

What do you do to treat pelvic pain?

The first and main thing is to evaluate and determine what systems are affected, then develop a treatment plan that will treat all the issues. Many times, there are dietary/behavioral changes that the patient must do along with our treatment protocols. We utilize a multidisciplinary approach with physical therapists trained in the pelvic floor, along with innovative treatments to treat nerves that are affected which are difficult to treat.  We have had much success with the amniotic cell allograft in treating pudendal nerve pain. We also utilize Botox. There are times when laparoscopy with excision of endometriosis, remove a cyst or appendix is necessary. There are many treatment options, most of which are minimally invasive, or not invasive at all.

If you or a loved one are suffering from pelvic pain, schedule an appointment today with our qualified team of doctors at the Incontinence Institute in Tennessee.

If you have a cellphone or a tablet, chances are you’ve downloaded a few apps. And why not? There are well over two million apps available for download for both Apple and Android devices, designed to do all sorts of tasks from playing games to counting calories to balancing your budget to saving money of goods and services – and lots more. It shouldn’t be a big surprise, then, to learn there are also apps to help people with incontinence manage their condition more effectively. From bladder diaries to apps that find the nearest restroom to videos that remind you how and when to do Kegels, there are plenty of high-tech ways to keep your incontinence under control. Here are just a few in 2018 to consider (and most are free!):

1. Sit or Squat

Available for: iPhone, Android
This app for Android and Apple is sponsored by toilet paper manufacturer Charmin and helps users find the nearest public restroom, no matter where you are in the United States.

2. BladderPal

Available for: iPhone, Android
Available for Android and Apple devices, BladderPal lets you keep track of your fluid intake and urine output, two critical measurements that are frequently used by incontinence doctors to measure your level of incontinence and track your progress with treatments.

3. UroBladderDiary

Available for: iPhone
UroBladderDiary is an iPhone only app that records liquid intake and outtake, frequency, urgency, and leakage. The app can also create a custom report that can be sent in a PDF to your doctor. This app is the perfect replacement for a paper voiding diary that is frequently recommended by physicians.

4. Kegel Trainer PFM Exercises

Available for: iPhone, Android
Also available for both types of devices, Kegel Trainer gives you 10 different exercises to practice Kegels. If you’re prone to forget, use the app to set daily reminders.

5. Tät

Available for: iPhone, Android
Tät is an Android and iPhone app with 6 basic and 6 advanced pelvic floor music training sessions. It was developed by a Swedish company who used the app in a study for stress incontinence. In the study, 9 out of 10 women who used the app improved compared to 2 out of 10 women who improved while not using the app.

In addition, YouTube has plenty of videos for Kegels and other pelvic strengthening exercises for men and women, as well as yoga videos to ease the stress and anxiety that can accompany the condition and even contribute to it.

Before beginning any at-home treatment, it’s critical you have your symptoms evaluated by an incontinence specialist. In some cases, incontinence can be a sign of a serious underlying medical condition, and having an evaluation is the best way to be sure you get the right care, right away. If you live in Tennessee, the Incontinence Institute can help! Call our discrete concierge today at 615-525-5253 to schedule your own evaluation and consultation.

For sufferers of urinary incontinence, making sure you are always prepared and protected can be a costly job. The average individual with moderate urinary incontinence will use around two disposable pads a day. With each going for $1.30-1.50, they can expect to spend around $80 per month. However, if you are using more than two disposable incontinence pads per day or require more expensive products with better absorption and performance, those numbers can quickly climb. In fact, if we project those numbers to a year’s time, it comes out to a total of nearly $1000 – money that could have been spent treating this problem.

Alternative Reusable Solutions

Various disposable solutions exist for incontinence sufferers. Reusable incontinence pads can be purchased for a larger upfront investment but long-term cost-effectiveness. Pads are made of various washable materials, some of the most popular including cloth, organic cotton, and hemp.

Why use reusable products?

Health

While disposable pads are largely comprised of cotton, manufacturers of washable incontinence products frequently use cloth in its place. However, you also have the option of choosing chemical-free organic products. By choosing organic products, you protect your body from materials that may have been treated with herbicides, fungicides, and pesticides. Additionally, you don’t run the risk of exposing yourself to toxic chemical residue.

Environmental Impact

Using and discarding countless disposable pads puts a real burden on the environment. By switching to reusable incontinence pads, you’re keeping plastic out of landfills and pollutants out of the environment.

Higher Quality

One large benefit of reusable products is that they can be created with custom sizing. Some cloth reusable products are created to be both self-sanitizing and also fast drying. Higher quality also translates to higher comfort, with a better fit and thus better performing product.

Cost

Incontinence products are on average six times more expensive than baby diapers or menstrual pads. Unlike menstrual pads which may be used a couple of days out of the month, many incontinence sufferers have to wear them 24/7. It is suggested that incontinence sufferers purchase at least 6 reusable pads or briefs. While they cost about $20 each, reusable incontinence products are generally advertised to last for 300 uses. The yearly savings on reusable incontinence pads compared to disposables averages eight hundred dollars! Plus, they can be quickly and easily sanitized in your home, using just your washer and dryer.

Get Incontinence Treatment at the Incontinence Institute

By switching to washable incontinence products, you’ll have extra money to treat what is causing your incontinence. While incontinence issues are common, they are not just a normal part of aging – there are treatments that can help. To start treating the root cause of your incontinence, contact one of our professionals today for a consultation in Middle Tennessee.

It is not uncommon to hear of pregnant women having trouble holding their bladders. In fact, 67% of women report some degree of urinary incontinence during pregnancy. But what happens if a mother is still struggling with the involuntary loss of urine a few years after childbirth? She may be suffering from postpartum incontinence.

What is Postpartum Incontinence?

There are two main categories of postpartum incontinence: stress incontinence and urge incontinence. Many women experience both.

Stress incontinence

The first is referred to as stress incontinence, where the loss of urine is caused by increased pressure or stress in the body. It is frequently correlated with a weakening of the pelvic floor muscles or pelvic muscles that have lost normal function due to overuse. If running, jumping, or a sneeze, coughing, or laughing sends you to the restroom, you may be experiencing stress incontinence.

Urge incontinence

The second category of postpartum incontinence is called urge incontinence. It is most often caused by nerve damage sustained while pregnant or delivering, which impairs the bladder’s ability to communicate with one’s brain. As a result, the bladder may signal a need to use the restroom too soon or too often. Women with urge incontinence may suddenly feel like they’ve “got to go”, even when their bladders are nearly empty. The onset of these feelings may be quick and intense, and leaks may happen before they can make it to the restroom.

What causes urinary incontinence after childbirth?

Women who had a vaginal delivery are most likely to be affected, with up to 25% experiencing symptoms that persist for at least 1 year postpartum. In contrast, it affects up to 16% of women having had a caesarian section delivery.

Furthermore, obese women or women over the age of 35 are at an increased risk of postpartum urinary incontinence. Likewise, the use of forceps in delivery, smoking, and incontinence during pregnancy predict a higher likelihood of postpartum incontinence.

Unfortunately, even though urinary incontinence after childbirth is extremely common, 77% of women who have postpartum incontinence either do not know or never seek a formal diagnosis and as a result, they will never receive treatment.

Treatment for urinary incontinence after childbirth

Postpartum incontinence greatly affects the daily lives of those who have it. Many women resort to always wearing pads, visiting the restroom frequently, and even drinking less to minimize fluid in the bladder. Yet none of these methods offer a permanent solution.

Botox®

Botox® is a good solution for urge incontinence issues, as it relieves symptoms by calming the nerves that overstimulate your bladder. For treatment, it is injected into your bladder muscle. It takes less than 15 minutes and is performed with local or general anesthesia on an outpatient basis. This treatment cannot be done while pregnant, but it is an option for women who are planning to become pregnant or are in between pregnancies.

Bladder Sling

If you are suffering from stress incontinence issues, a bladder sling surgery may be the right treatment for you. For this procedure, a sling is attached to your abdominal wall to lift the urethra to its normal position. It will then put pressure on your urethra to assist with urine retention.

Sacral Neuromodulation

A sacral neuromodulation device goes underneath the skin of the pelvis above the buttocks, which emits tiny electrical pulses that target an area near the sacral nerves to adjust neural activity controlling the bladder and bowels. The process is a minimally invasive surgery performed at an outpatient surgery center that takes between 20-30 minutes to complete.

Find Postpartum Incontinence Relief with the Incontinence Institute

In every urinary incontinence case, our board-certified physicians work closely with patients to create customized plans that cater directly to your unique needs. Contact us today to schedule an appointment and regain control – because no one should have to live with leaks.

Melissa Kaufman, M.D., Ph.D., associate professor of Urologic Surgery, received the 2017 Zimskind Award at the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) Winter Meeting in Scottsdale, Arizona.

The Zimskind Award, established in 1979, is awarded to an individual who, within 10 years of completing residency or fellowship, has made significant contributions to the field, primarily through basic and clinical research, and has shown great potential for continuing and progressive scholarship.

“The Zimskind award represents the highest possible achievement for a mid-career specialist in lower urinary tract and female pelvic floor dysfunction. This is a singular recognition of an outstanding individual,” said Roger Dmochowski, M.D., professor of Urologic Surgery.

Dmochowski, who serves on the SUFU board, received the Zimskind Award in 1999.

Kaufman completed her Ph.D. in Biology at the University of Tennessee and obtained her medical degree from the University of Arkansas College of Medicine.

She completed her general urology residency at Vanderbilt and a Female Pelvic Medicine and Reconstructive Surgery fellowship under the direction of Dmochowski.

She is also a past president of the Society of Women in Urology (SWUI).

Provided by Vanderbilt University Medical Center’s Reporter